1952453243 NPI number — MISS TONYA RENEE ESTEP PT

Table of content: MISS TONYA RENEE ESTEP PT (NPI 1952453243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952453243 NPI number — MISS TONYA RENEE ESTEP PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTEP
Provider First Name:
TONYA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESTEP
Provider Other First Name:
TONYA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952453243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 PINE TOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40741-6202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-862-8333
Provider Business Mailing Address Fax Number:
606-862-8618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3104 PINE TOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-862-8333
Provider Business Practice Location Address Fax Number:
606-862-8618
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004016 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87000741 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 320005165 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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